Experimental investigation of the dose and image quality characteristics of a digital mammography imaging system

Our purpose in this study was to investigate the image quality and absorbed dose characteristics of a digital mammography imaging system with a CsI scintillator, and to identify an optimal x-ray tube voltage for imaging simulated masses in an average size breast with 50% glandularity. Images were taken of an ACR accreditation phantom using a LORAD digital mammography system with a Mo target and a Mo filter. In one experiment, exposures were performed at 80 mAs with x-ray tube voltages varying between 24 and 34 kVp. In a second experiment, the x-ray tube voltage was kept constant at 28 kVp and the technique factor was varied between 5 and 500 mAs. The average glandular dose at each x-ray tube voltage was determined from measurements of entrance skin exposure and x-ray beam half-value layer. Image contrast was measured as the fractional digital signal intensity difference for the image of a 4 mm thick acrylic disk. Image noise was obtained from the standard deviation in a uniformly exposed region of interest expressed as a fraction of the background intensity. The measured digital signal intensity was proportional to the mAs and to the kVp5.8. Image contrast was independent of mAs, and dropped by 21% when the x-ray tube voltage increased from 24 to 34 kVp. At a constant x-ray tube voltage, image noise was shown to be approximately proportional to (mAs)(-05), which permits the image contrast to noise ratio (CNR) to be modified by changing the mAs. At 80 mAs, increasing the x-ray tube voltage from 24 to 34 kVp increased the CNR by 78%, and increased the average glandular dose by 285%. At a constant lesion CNR, the lowest average glandular dose value occurred at 27.3 kVp. Increasing or decreasing the x-ray tube voltage by 2.3 kVp from the optimum kVp increased the average glandular dose values by 5%. These results show that imaging simulated masses in a 4.2 cm compressed breast at approximately 27 kVp with a Mo/Mo target/filter results in the lowest average glandular dose.     

Dual-energy cardiac imaging: an image quality and dose comparison for a flat-panel detector and x-ray image intensifier

This study presents a comparison of dual-energy imaging with an x-ray image intensifier and flat-panel detector for cardiac imaging. It also investigates if the wide dynamic range of the flat-panel detector can improve dual-energy image quality while reducing patient dose. Experimental contrast-to-noise (CNR) measurements were carried out in addition to simulation studies. Patient entrance exposure and system tube loading were also recorded. The studied contrast objects were calcium and iodine. System performance was quantified with a figure-of-merit (FOM) defined as the image CNR(2) over patient entrance exposure. The range of thickness studied was from 10 to 30 cm of Lucite (PMMA). Detector dose was initially set to 140 nGy (16 microR)/frame. The high-energy 120 kVp beam was filtered by an additional 0.8 mm silver filter. Keeping the same filament current, the kVp for the low-energy beam was adjusted as a function of thickness until 140 nGy was achieved. System performance was found to be similar for both systems, with the x-ray image intensifier performing better at lower thicknesses and the flat-panel detector performing better at higher thicknesses. This requirement of fixed detector entrance exposure was then relaxed and the kVp for the low-energy beam was allowed to vary while the mAs of the x-ray tube remained fixed to study changes in dual-energy image quality, patient dose and FOM with the flat-panel detector. It was found that as the kVp for the low-energy beam was reduced, system performance would rise until reaching a maximum while simultaneously lowering patient exposure. Suggested recommendations for optimal dual-energy imaging implementation are also provided.     

Theoretical and experimental studies of the influence of air kerma rate on threshold contrast in diagnostic fluoroscopy systems

Experimental measurements of threshold contrast (CT) as a function of air kerma rate at the input plane of the image intensifier have been made for several diagnostic fluoroscopy units in clinical use. Threshold contrasts are determined by viewing a test object containing holes of fixed diameter and various depths under defined irradiation conditions. Kerma rate variations are effected by introducing aluminum sheets into the x-ray beam at fixed values of tube potential and current. At low kerma rates where quantum noise dominates, low tube potentials (60 kVp) usually yield lower values of CT than do higher potentials (100 kVp). At higher kerma rates the opposite is often true. A simple theoretical model for noise propagation in fluoroscopic imaging systems using models of diagnostic x-ray spectra lends qualitative support to the experimental findings. The often-quoted suggested upper limit of 100 mu R s-1 (0.87 mu Gy s-1) at the input phosphor would seem to be justified under the test conditions since little improvement in CT is usually observed at higher kerma rates. However, application to clinical practice would ideally require the use of more realistic phantom studies.     

Comparison of entrance exposure and signal-to-noise ratio between an SBDX prototype and a wide-beam cardiac angiographic system

The scanning-beam digital x-ray (SBDX) system uses an inverse geometry, narrow x-ray beam, and a 2-mm thick CdTe detector to improve the dose efficiency of the coronary angiographic procedure. Entrance exposure and large-area iodine signal-to-noise ratio (SNR) were measured with the SBDX prototype and compared to that of a clinical cardiac interventional system with image intensifier (II) and charge coupled device (CCD) camera (Philips H5000, MRC-200 x-ray tube, 72 kWp max). Phantoms were 18.6-35.0 cm acrylic with an iohexol-equivalent disk placed at midthickness (35 mg/cm2 iodine radiographic density). Imaging was performed at 15 frame/s, with the disk at mechanical isocenter and an 11-cm object-plane field width. The II/CCD system was operated in cine mode with automatic exposure control. With the SBDX prototype at maximum x-ray output (120 kVp, 24.3 kWp), the SBDX SNR was 107%-69% of the II/CCD SNR, depending on phantom thickness, and the SBDX entrance exposure rate was 10.7-9.3 R/min (9.4-8.2 cGy/min air kerma). For phantoms where an equal-kVp imaging comparison was possible (> or = 23.3 cm), the SBDX SNR ranged from 47% to 69% of the II/CCD SNR while delivering 6% to 9% of the II/CCD entrance exposure rate. From these measurements it was determined that the relative SBDX entrance exposure at equal SNR would be 31%-16%. Results were consistent with a model for relative entrance exposure at equal SNR, which predicted a 3-7 times reduction in entrance exposure due to SBDX's comparatively low scatter fraction (5.5%-8.1% measured, including off-focus radiation), high detector detective quantum efficiency (66%-73%, measured from 70 to 120 kVp), and large entrance field area (1.7x - 2.3x, for the same object-plane field width). With improvements to the system geometry, detector, and x-ray source, SBDX technology is projected to achieve conventional cine-quality SNR over a full range of patient thicknesses, with 5-10 times lower skin dose.     

Patient size and x-ray technique factors in head computed tomography examinations. II. Image quality

We investigated how patient head characteristics, as well as the choice of x-ray technique factors, affect lesion contrast and noise values in computed tomography (CT) images. Head sizes and mean Hounsfield unit (HU) values were obtained from head CT images for five classes of patients ranging from the newborn to adults. X-ray spectra with tube voltages ranging from 80 to 140 kV were used to compute the average photon energy, and energy fluence, transmitted through the heads of patients of varying size. Image contrast, and the corresponding contrast to noise ratios (CNRs), were determined for lesions of fat, muscle, and iodine relative to a uniform water background. Maintaining a constant image CNR for each lesion, the patient energy imparted was also computed to identify the x-ray tube voltage that minimized the radiation dose. For adults, increasing the tube voltage from 80 to 140 kV changed the iodine HU from 2.62 x 10(5) to 1.27 x 10(5), the fat HU from -138 to -108, and the muscle HU from 37.1 to 33.0. Increasing the x-ray tube voltage from 80 to 140 kV increased the percentage energy fluence transmission by up to a factor of 2. For a fixed x-ray tube voltage, the percentage transmitted energy fluence in adults was more than a factor of 4 lower than for newborns. For adults, increasing the x-ray tube voltage from 80 to 140 kV improved the CNR for muscle lesions by 130%, for fat lesions by a factor of 2, and for iodine lesions by 25%. As the size of the patient increased from newborn to adults, lesion CNR was reduced by about a factor of 2. The mAs value can be reduced by 80% when scanning newborns while maintaining the same lesion CNR as for adults. Maintaining the CNR of an iodine lesion at a constant level, use of 140 kV increases the energy imparted to an adult patient by nearly a factor of 3.5 in comparison to 80 kV. For fat and muscle lesions, raising the x-ray tube voltage from 80 to 140 kV at a constant CNR increased the patient dose by 37% and 7%, respectively. Our two key findings are that for head CT examinations performed at a constant CNR, the mAs can be substantially reduced when scanning infants, and that use of the lowest x-ray tube voltage will generally reduce patient doses.     

Quantification techniques for dual-energy cardiac imaging

We have previously reported a motion immune dual-energy subtraction technique in which x-ray tube voltage and x-ray beam filtration are switched at 30 Hz between 60 kVp (2.0-mm Al filter) and 120 kVp (2.0-mm Al + 2.5-mm Cu filtration). In this paper we consider the suitability of these dual-energy images for quantitative measurements of iodine thickness and volume. Optimized iodine signal-to-noise ratio (S/N) was measured as a function of phantom thickness. Using a fixed mAs, the S/N of the dual-energy images was found to decrease by sevenfold as lucite thickness increased from 10 to 25 cm. For the same increase in lucite thickness S/N for time subtraction images decreased by fivefold. Image quality in two human volunteers was subjectively judged to be good. In order to quantitate physiological parameters such as ejection fraction and left ventricular volume, energy dependent corrections for scatter and veiling glare, beam hardening, detector nonuniformity, heel effect, and uncanceled bone signals were developed. Since the dual-energy technique does not completely cancel bone, a preinjection dual-energy subtraction image was used to estimate integrated bone contributions to iodine volume measurements. In a phantom measurement simulating exercise ventriculography, the known (Vk) and videodensitometrically measured (Vm) volumes of 19 mg/cm3 solution of iodine were related by Vm = 0.95 Vk + 1.50 cm3 (r greater than 0.99).     

Radiation dose and image quality for paediatric interventional cardiology

Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 microGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 microGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.     

Visibility of microcalcification in cone beam breast CT: effects of X-ray tube voltage and radiation dose

Mammography is the only technique currently used for detecting microcalcification (MC) clusters, an early indicator of breast cancer. However, mammographic images superimpose a three-dimensional compressed breast image onto two-dimensional projection views, resulting in overlapped anatomical breast structures that may obscure the detection and visualization of MCs. One possible solution to this problem is the use of cone beam computed tomography (CBCT) with a flat-panel (FP) digital detector. Although feasibility studies of CBCT techniques for breast imaging have yielded promising results, they have not shown how radiation dose and x-ray tube voltage affect the accuracy with which MCs are detected by CBCT experimentally. We therefore conducted a phantom study using a FP-based CBCT system with various mean glandular doses and kVp values. An experimental CBCT scanner was constructed with a data acquisition rate of 7.5 frames/s. 10.5 and 14.5 cm diameter breast phantoms made of gelatin were used to simulate uncompressed breasts consisting of 100% glandular tissue. Eight different MC sizes of calcium carbonate grains, ranging from 180-200 microm to 355-425 microm, were used to simulate MCs. MCs of the same size were arranged to form a 5 x 5 MC cluster and embedded in the breast phantoms. These MC clusters were positioned at 2.8 cm away from the center of the breast phantoms. The phantoms were imaged at 60, 80, and 100 kVp. With a single scan (360 degrees), 300 projection images were acquired with 0.5 x, 1x, and 2x mean glandular dose limit for 10.5 cm phantom and with 1x, 2x, and 4x for 14.5 cm phantom. A Feldkamp algorithm with a pure ramp filter was used for image reconstruction. The normalized noise level was calculated for each x-ray tube voltage and dose level. The image quality of the CBCT images was evaluated by counting the number of visible MCs for each MC cluster for various conditions. The average percentage of the visible MCs was computed and plotted as a function of the MGD, the kVp, and the average MC size. The results showed that the MC visibility increased with the MGD significantly but decreased with the breast size. The results also showed that the x-ray tube voltage affects the detection of MCs under different circumstances. With a 50% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 348(+/-2), 288(+/-7), 257(+/-2) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 355 (+/-1), 307 (+/-7), 275 (+/-5) microm at 6, 12, and 24 mGy, respectively. With a 75% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 367 (+/-1), 316 (+/-7), 265 (+/-3) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 377 (+/-3), 334 (+/-5), 300 (+/-2) microm at 6, 12, and 24 mGy, respectively.     

A search for improved technique factors in paediatric fluoroscopy

A Monte Carlo computational model of a fluoroscopic imaging chain was used for deriving optimal technique factors for paediatric fluoroscopy. The optimal technique was defined as the one that minimizes the absorbed dose (or dose rate) in the patient with a constraint of constant image quality. Image quality was assessed for the task of detecting a detail in the image of a patient-simulating phantom, and was expressed in terms of the ideal observer's signal-to-noise ratio (SNR) for static images and in terms of the accumulating rate of the square of SNR for dynamic imaging. The entrance air kerma (or air kerma rate) and the mean absorbed dose (or dose rate) in the phantom quantified radiation detriment. The calculations were made for homogeneous phantoms simulating newborn, 3-, 10- and 15-year-old patients, barium and iodine contrast material details, several x-ray spectra, and for imaging with or without an antiscatter grid. The image receptor was modelled as a CsI x-ray image intensifier (XRII). For the task of detecting low- or moderate-contrast iodine details, the optimal spectrum can be obtained by using an x-ray tube potential near 50 kV and filtering the x-ray beam heavily. The optimal tube potential is near 60 kV for low- or moderate-contrast barium details, and 80-100 kV for high-contrast details. The low-potential spectra above require a high tube load, but this should be acceptable in paediatric fluoroscopy. A reasonable choice of filtration is the use of an additional 0.25 mm Cu, or a suitable K-edge filter. No increase in the optimal tube potential was found as phantom thickness increased. With the constraint of constant low-contrast detail detectability, the mean absorbed doses obtained with the above spectra are approximately 50% lower than those obtained with the reference conditions of 70 kV and 2.7 mm Al filter. For the smallest patient and x-ray field size, not using a grid was slightly more dose-efficient than using a grid, but when the patient size and field size were increased a fibre interspaced grid resulted in lower doses than imaging without a grid. For a 15-year-old patient the mean absorbed doses were up to 40% lower with this grid than without the grid.     

Computed tomography with energy-resolved detection: a feasibility study

The feasibility of computed tomography (CT) with energy-resolved x-ray detection has been investigated. A breast CT design with multi slit multi slice (MSMS) data acquisition was used for this study. The MSMS CT includes linear arrays of photon counting detectors separated by gaps. This CT configuration allows for efficient scatter rejection and 3D data acquisition. The energy-resolved CT images were simulated using a digital breast phantom and the design parameters of the proposed MSMS CT. The phantom had 14 cm diameter and 50/50 adipose/glandular composition, and included carcinoma, adipose, blood, iodine and CaCO3 as contrast elements. The x-ray technique was 90 kVp tube voltage with 660 mR skin exposure. Photon counting, charge (energy) integrating and photon energy weighting CT images were generated. The contrast-to-noise (CNR) improvement with photon energy weighting was quantified. The dual energy subtracted images of CaCO3 and iodine were generated using a single CT scan at a fixed x-ray tube voltage. The x-ray spectrum was electronically split into low- and high-energy parts by a photon counting detector. The CNR of the energy weighting CT images of carcinoma, blood, adipose, iodine, and CaCO3 was higher by a factor of 1.16, 1.20, 1.21, 1.36 and 1.35, respectively, as compared to CT with a conventional charge (energy) integrating detector. Photon energy weighting was applied to CT projections prior to dual energy subtraction and reconstruction. Photon energy weighting improved the CNR in dual energy subtracted CT images of CaCO3 and iodine by a factor of 1.35 and 1.33, respectively. The combination of CNR improvements due to scatter rejection and energy weighting was in the range of 1.71-2 depending on the type of the contrast element. The tilted angle CZT detector was considered as the detector of choice. Experiments were performed to test the effect of the tilting angle on the energy spectrum. Using the CZT detector with 20 degrees tilting angle decreased the tailing of the measured x-ray spectrum as compared to a conventional CZT detector. It was concluded that the energy-resolved MSMS CT with tilted angle CZT detector is potentially feasible and could provide a unique combination of photon counting, energy weighting, scatter rejection and single kVp dual energy subtraction CT imaging.     

Dual-energy approach to contrast-enhanced mammography using the balanced filter method: spectral optimization and preliminary phantom measurement

Dual-energy contrast agent-enhanced mammography is a technique of demonstrating breast cancers obscured by a cluttered background resulting from the contrast between soft tissues in the breast. The technique has usually been implemented by exploiting two exposures to different x-ray tube voltages. In this article, another dual-energy approach using the balanced filter method without switching the tube voltages is described. For the spectral optimization of dual-energy mammography using the balanced filters, we applied a theoretical framework reported by Lemacks et al. [Med. Phys. 29, 1739-1751 (2002)] to calculate the signal-to-noise ratio (SNR) in an iodinated contrast agent subtraction image. This permits the selection of beam parameters such as tube voltage and balanced filter material, and the optimization of the latter's thickness with respect to some critical quantity-in this case, mean glandular dose. For an imaging system with a 0.1 mm thick CsI:T1 scintillator, we predict that the optimal tube voltage would be 45 kVp for a tungsten anode using zirconium, iodine, and neodymium balanced filters. A mean glandular dose of 1.0 mGy is required to obtain an SNR of 5 in order to detect 1.0 mg/cm2 iodine in the resulting clutter-free image of a 5 cm thick breast composed of 50% adipose and 50% glandular tissue. In addition to spectral optimization, we carried out phantom measurements to demonstrate the present dual-energy approach for obtaining a clutter-free image, which preferentially shows iodine, of a breast phantom comprising three major components-acrylic spheres, olive oil, and an iodinated contrast agent. The detection of iodine details on the cluttered background originating from the contrast between acrylic spheres and olive oil is analogous to the task of distinguishing contrast agents in a mixture of glandular and adipose tissues.     

Image intensifier distortion correction

A method is described for determining and correcting the spatial distortion affecting images acquired with image-intensified video systems. The distortion is separated into two physically distinct components, a predominant one originating from the projection of the x-ray image onto the curved input phosphor, and a smaller component corresponding to the mapping from the input phosphor to the output phosphor and the digital image matrix. The former is determined geometrically and the latter is modeled with four empirical parameters. A method for determining the two components from calibration images of a grid phantom is presented. The model of the image intensifier distortion was found to be in good agreement with the measured distortion in the images. The correction is applicable to arbitrary angulations of the x-ray beam with respect to the image intensifier tube, and consequently is directly applicable to digital tomosynthesis. The correction allows one to obtain accurate positional information with fluorography and may also be useful in radiation therapy treatment planning and quantitative digital subtraction angiography.     

Quantification of the effect of kvp on edge-enhancement index in phase-contrast radiography

This study was performed to measure the dependence of edge-enhancement in polychromatic phase-contrast radiography on x-ray tube operating voltage. Measurements of edge enhancement were made at tube voltages from 40 to 86 kVp using a tungsten anode x-ray tube with a nominal focal spot size of 100 micrometers. A relatively weak attenuating, sharp edge consisting of a thin lucite sheet (3 mm) in air was imaged utilizing phase-contrast radiography (PC-R). PC-R images were acquired at different radiographic techniques in which x-ray tube voltage was varied from 40 to 86 kVp. The image receptor was a single emulsion x-ray mammography cassette. Optical density profiles across the edge of the object were obtained using a film digitizer and edge-enhancement indices were calculated. Increasing kVp resulted in a gradual decrease of the edge-enhancement index. Even at the highest kVp (86), however, important edge-enhancement effects were evident. While there is some degradation in the edge-enhancement effect of phase-contrast radiography at higher kVps, the decrease from 40 to 86 kVp is relatively small (11%). Our results suggest that further investigation into the role of phase-contrast imaging at higher kVp values for the purpose of patient dose reduction while still realizing the advantage of phase-contrast effects for improved soft-tissue detectability is warranted.     

Energy-resolved computed tomography: first experimental results

First experimental results with energy-resolved computed tomography (CT) are reported. The contrast-to-noise ratio (CNR) in CT has been improved with x-ray energy weighting for the first time. Further, x-ray energy weighting improved the CNR in material decomposition CT when applied to CT projections prior to dual-energy subtraction. The existing CT systems use an energy (charge) integrating x-ray detector that provides a signal proportional to the energy of the x-ray photon. Thus, the x-ray photons with lower energies are scored less than those with higher energies. This underestimates contribution of lower energy photons that would provide higher contrast. The highest CNR can be achieved if the x-ray photons are scored by a factor that would increase as the x-ray energy decreases. This could be performed by detecting each x-ray photon separately and measuring its energy. The energy selective CT data could then be saved, and any weighting factor could be applied digitally to a detected x-ray photon. The CT system includes a photon counting detector with linear arrays of pixels made from cadmium zinc telluride (CZT) semiconductor. A cylindrical phantom with 10.2 cm diameter made from tissue-equivalent material was used for CT imaging. The phantom included contrast elements representing calcifications, iodine, adipose and glandular tissue. The x-ray tube voltage was 120 kVp. The energy selective CT data were acquired, and used to generate energy-weighted and material-selective CT images. The energy-weighted and material decomposition CT images were generated using a single CT scan at a fixed x-ray tube voltage. For material decomposition the x-ray spectrum was digitally spilt into low- and high-energy parts and dual-energy subtraction was applied. The x-ray energy weighting resulted in CNR improvement of calcifications and iodine by a factor of 1.40 and 1.63, respectively, as compared to conventional charge integrating CT. The x-ray energy weighting was also applied to low- and high-energy CT projections used for material decomposition. This improved the CNR in images of decomposed calcification and iodine by a factor of 1.57 and 1.46, respectively, as compared to conventional charge integrating CT. Some limitations were observed due to hole trapping in CZT and charge sharing between the detector pixels. First experimental results demonstrate that energy-resolved CT is coming close to its practical applications. Although hole trapping and charge sharing in CZT deteriorates x-ray spectrum and limits CNR improvement with energy weighting and detector count rate, this problem has a feasible solution, which is discussed in this paper and is a matter of ongoing research.     

Automatic exposure control in multichannel CT with tube current modulation to achieve a constant level of image noise: experimental assessment on pediatric phantoms

Automatic exposure control (AEC) systems have been developed by computed tomography (CT) manufacturers to improve the consistency of image quality among patients and to control the absorbed dose. Since a multichannel helical CT scan may easily increase individual radiation doses, this technical improvement is of special interest in children who are particularly sensitive to ionizing radiation, but little information is currently available regarding the precise performance of these systems on small patients. Our objective was to assess an AEC system on pediatric dose phantoms by studying the impact of phantom transmission and acquisition parameters on tube current modulation, on the resulting absorbed dose and on image quality. We used a four-channel CT scan working with a patient-size and z-axis-based AEC system designed to achieve a constant noise within the reconstructed images by automatically adjusting the tube current during acquisition. The study was performed with six cylindrical poly(methylmethacrylate) (PMMA) phantoms of variable diameters (10-32 cm) and one 5 years of age equivalent pediatric anthropomorphic phantom. After a single scan projection radiograph (SPR), helical acquisitions were performed and images were reconstructed with a standard convolution kernel. Tube current modulation was studied with variable SPR settings (tube angle, mA, kVp) and helical parameters (6-20 HU noise indices, 80-140 kVp tube potential, 0.8-4 s. tube rotation time, 5-20 mm x-ray beam thickness, 0.75-1.5 pitch, 1.25-10 mm image thickness, variable acquisition, and reconstruction fields of view). CT dose indices (CTDIvol) were measured, and the image quality criterion used was the standard deviation of the CT number measured in reconstructed images of PMMA material. Observed tube current levels were compared to the expected values from Brooks and Di Chiro's [R.A. Brooks and G.D. Chiro, Med. Phys. 3, 237-240 (1976)] model and calculated values (product of a reference value multiplied by a dose ratio measured with thermoluminescent dosimeters). Our study demonstrates that this AEC system accurately modulates the tube current according to phantom size and transmission to achieve a stable image noise. The system accurately controls the tube current when changing tube rotation time, tube potential, or image thickness, with minimal variations of the resulting noise. Nevertheless, CT users should be aware of possible changes of tube current and resulting dose and quality according to several parameters: the tube angle and tube potential used for SPR, the x-ray beam thickness (tube current decreases and image noise increases when doubling x-ray beam thickness), the pitch value (a pitch decrease leads to a higher dose but also to a higher noise), and the acquisition field of view (FOV) (tube current is lower when using the small acquisition FOV compared to the large one, but the use of small acquisition FOV at 120 kVp leads to a peculiar increase of tube current and CTDIvol).     

Photon counting spectral CT: improved material decomposition with K-edge-filtered x-rays

Photon counting spectral computed tomography (PCSCT) provides material selective CT imaging at a single CT scan and fixed tube voltage. The PCSCT data are acquired in several energy ranges (bins) arranged over the x-ray spectrum. The quasi-monoenergetic CT images are acquired in these energy bins and are used for material decomposition. The PCSCT exhibits inherent limitations when material decomposition is performed using energy bins. For effective material decomposition, the energy bins used for material decomposition should be sufficiently narrow and well separated. However, when narrow bins are used, a large fraction of the detected x-ray counts is lost and statistical noise is increased. Alternatively, the x-ray spectrum can be split into a few larger bins with no gap in between and all detected x-ray photons can be used for material decomposition. However, in this case the energy bins are too wide and not well separated, which results in suboptimal material decomposition. The above contradictory requirements can be resolved if the x-ray photons are physically removed from the regions of the energy spectrum between the energy bins. Such a selective removal can be performed using filtration of the x-ray beam by high-Z filter materials with appropriate positions of K-edge energies. The K-edge filtration of x-rays can, therefore, provide necessary gaps between the energy bins with no dose penalty to the patient. In the current work, we proposed using selective K-edge filtration of x-rays in PCSCT and performed the first experimental investigation of this approach. The PCSCT system included a cadmium zinc telluride semiconductor detector with 2 × 256 pixels and 1 × 1 mm(2) pixel size, and five energy bins. The CT phantom had 14 cm diameter and included contrast elements of iodine, gold and calcifications with clinically relevant concentrations. The tube voltages of 60, 90 and 120 kVp were used. K-edge filters based on Ba (E(k) = 37.44 keV) were used for a 60 kVp tube voltage and Gd (E(k) = 50.24 keV) was used for the 90 and 120 kVp tube voltages, respectively. The material selective CT images were also acquired with conventional Al filtration for comparison. The half-value layers of x-ray beams after K-edge and Al filtration were matched. The mean entrance skin exposure was 280 mR for all tube voltages and filters. The contrast-to-noise ratio (CNR) in material-decomposed images was approximately 30%-50% higher when K-edge filters were used instead of Al filters. It was concluded that K-edge filtration of x-rays provides substantial improvement of the CNR in material-selective PCSCT. Further optimization of K-edge filter materials, tube voltages, detector technology and energy bin settings will provide even higher CNR in decomposed images.     

Effective dose efficiency: an application-specific metric of quality and dose for digital radiography

The detective quantum efficiency (DQE) and the effective DQE (eDQE) are relevant metrics of image quality for digital radiography detectors and systems, respectively. The current study further extends the eDQE methodology to technique optimization using a new metric of the effective dose efficiency (eDE), reflecting both the image quality as well as the effective dose (ED) attributes of the imaging system. Using phantoms representing pediatric, adult and large adult body habitus, image quality measurements were made at 80, 100, 120 and 140 kVp using the standard eDQE protocol and exposures. ED was computed using Monte Carlo methods. The eDE was then computed as a ratio of image quality to ED for each of the phantom/spectral conditions. The eDQE and eDE results showed the same trends across tube potential with 80 kVp yielding the highest values and 120 kVp yielding the lowest. The eDE results for the pediatric phantom were markedly lower than the results for the adult phantom at spatial frequencies lower than 1.2-1.7 mm(-1), primarily due to a correspondingly higher value of ED per entrance exposure. The relative performance for the adult and large adult phantoms was generally comparable but affected by kVps. The eDE results for the large adult configuration were lower than the eDE results for the adult phantom, across all spatial frequencies (120 and 140 kVp) and at spatial frequencies greater than 1.0 mm(-1) (80 and 100 kVp). Demonstrated for chest radiography, the eDE shows promise as an application-specific metric of imaging performance, reflective of body habitus and radiographic technique, with utility for radiography protocol assessment and optimization.     

Effects of x-ray spectra on the DQE of a computed radiography system

The effect of incident x-ray beam quality on the measured detective quantum efficiency (DQE) of a computed radiography system was investigated. The incident x-ray beams used had peak tube potentials of 70, 95, and 120 kVp, were filtered with various thicknesses of a "patient equivalent phantom" (PEP), aluminum, and copper, and provided a consistent exposure to the storage phosphor. For each peak tube potential and filter combination, the one-dimensional modulation transfer function and noise power spectrum were measured and the square of the incident signal-to-noise ratio was estimated. The spatial frequency dependent DQE was calculated from these data. The DQE was integrated to provide an overall estimate of the efficiency and frequency response of the computed radiography system for the various x-ray beams. There was found to be a wide range of integral DQE (IDQE) values for the peak tube potential and filter combinations used. For example, the IDQE ranged from 3.0 to 0.9 mm(-2) using the peak tube potential and filter combinations 70 kVp with 5.1 cm PEP and 120 kVp with 30.3 cm PEP, respectively. Finally, peak tube potential and filter combinations 70 kVp with 10.2 cm PEP and 120 kVp with 20.2 cm PEP were chosen as standard x-ray beams that will be used at our facility to measure the DQE of digital radiographic imaging systems for evaluation and acceptance testing.     

Optimization of exposure parameters in full field digital mammography

Optimization of exposure parameters (target, filter, and kVp) in digital mammography necessitates maximization of the image signal-to-noise ratio (SNR), while simultaneously minimizing patient dose. The goal of this study is to compare, for each of the major commercially available full field digital mammography (FFDM) systems, the impact of the selection of technique factors on image SNR and radiation dose for a range of breast thickness and tissue types. This phantom study is an update of a previous investigation and includes measurements on recent versions of two of the FFDM systems discussed in that article, as well as on three FFDM systems not available at that time. The five commercial FFDM systems tested, the Senographe 2000D from GE Healthcare, the Mammomat Novation DR from Siemens, the Selenia from Hologic, the Fischer Senoscan, and Fuji's 5000MA used with a Lorad M-IV mammography unit, are located at five different university test sites. Performance was assessed using all available x-ray target and filter combinations and nine different phantom types (three compressed thicknesses and three tissue composition types). Each phantom type was also imaged using the automatic exposure control (AEC) of each system to identify the exposure parameters used under automated image acquisition. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the image SNR to the mean glandular dose. The results show that, for a given target/filter combination, in general FOM is a slowly changing function of kVp, with stronger dependence on the choice of target/filter combination. In all cases the FOM was a decreasing function of kVp at the top of the available range of kVp settings, indicating that higher tube voltages would produce no further performance improvement. For a given phantom type, the exposure parameter set resulting in the highest FOM value was system specific, depending on both the set of available target/filter combinations, and on the receptor type. In most cases, the AECs of the FFDM systems successfully identified exposure parameters resulting in FOM values near the maximum ones, however, there were several examples where AEC performance could be improved.     

Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 +/- 16 microGy and 43 +/- 19 microGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 +/- 3.7 microSv, regardless of sex, and an imparted energy of 18.5 +/- 6.7 microJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 +/- 7.6 microSv (males)/17.2 +/- 7.6 microSv (females) and 29.7 +/- 13.2 microJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.